Barriers and Motivators of Hand Hygiene among Pediatric Healthcare Workers in the Emergency Department

Background: Despite efforts to improve healthcare worker (HCW) hand hygiene, compliance remains low. Inpatient studies have revealed that HCW hand hygiene behavior is influenced by multiple factors.

Objective: To understand the barriers and motivators that influence the hand hygiene practices of HCWs in a pediatric emergency department (ED).

Methods: This was a cross-sectional survey performed in the ED of a large free-standing children’s hospital. An anonymous, self-administered, 24-question paper survey was distributed from April 13 through May 31, 2010 to all 204 HCWs working in the ED. Question topics included demographic characteristics, hand hygiene product preference, barriers and motivators of hand hygiene, and likelihood to remind or thank other HCWs for performing hand hygiene.

Results: A total of 118 HCWs (58%) completed the survey. Survey respondents included 27 (23%) attending physicians, 47 (40%) residents or fellows, and 41(35%) nurses or patient care technicians. Hand hygiene was very or extremely important to all HCWs. Alcohol-based hand products were preferred by 66% of physicians vs. 29% of nurses and technicians.  Lack of available supplies, forgetfulness, and emergency situations were the most frequently perceived barriers.  Protecting patients, themselves, and their own families from infection were important motivators for all HCWs to perform hand hygiene.  Awareness of being a role model was a very or extremely important motivator for hand hygiene for 24 (89%) attending physicians but only 23 (55%) residents. An individual’s awareness of their own compliance data was considered a very or extremely important motivator for 35 (85%) nurses and technicians but only 36 (49%) physicians. Forty-nine (41.5%) HCWs reported that reminding others to perform hand hygiene was not very or not at all difficult, but very few HCWs actually recalled reminding another HCW to perform hand hygiene. Conversely, 82 (69.5%) HCWs reported that thanking others for performing hand hygiene was not very or not at all difficult.

Conclusions: HCWs in the ED cite multiple barriers and motivators of hand hygiene and these vary by HCW type. Improvement interventions in the ED should be tailored to address HCW type-specific barriers and motivators. HCWs may be more likely to engage in positive feedback to encourage others to perform hand hygiene.